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Brucellosis and other zoonoses
Histoplasmosis is a systemic mycosis with a worldwide distribution. It is transmitted by inhalation of propagules of the dimorphic fungus Histoplasma capsulatum. Soil is the natural habitat of the fungus and human disease is associated with exposure to infected soil or excreta from birds and bats in endemic areas. The spectrum of disease ranges from asymptomatic acquisition to life-threatening disseminated disease. However, the majority of infections are subclinical [1]. Notably, histoplasmosis occurs in immunocompromised [2] and healthy individuals [1]. Clinically significant disease in healthy individuals is often a sequela of exposure to a high inoculum of H. capsulatum [1].
There are numerous reports of histoplasmosis outbreaks in individuals exposed to accumulated bat faeces, such as workers involved in cleaning or demolishing buildings [3] or tourists visiting caves containing bats [4]. Histoplasmosis is a relatively common fungal disease in Brazil; however, it is not included in Brazil's mandatory disease notification system and no official data on the disease are available. Our group recently participated in a study evaluating the mortality due to systemic mycoses from 1996 to 2006 in Brazil. Histoplasmosis accounted for 4·3% of deaths, but, when associated with AIDS, the frequency increased to 10·1% [5]. During August 2003 to December 2008, bats were either captured with mist nets by the Zoonosis Control Centre-SP (ZCC-SP) as part of the rabies control programme or were sent by individuals and by other zoonosis control centres from other cities in São Paulo State to our centre for study. Some of these sick or injured bats were caught on the ground. The species recognition of the bats was made according to the identification key of Vizotto & Taddei [6].
The city of São Paulo is the largest economic centre in Brazil and the most populous city of South America, with about 10·9 million inhabitants in an area of 1523 km2. The other cities in the state of São Paulo that participated in the study are Guarulhos with 1·2 million inhabitants (area 318 km2); Osasco with 700 000 inhabitants (area 65 km2); Jundiaí with 340 000 inhabitants (area 432 km2); and Mogi Mirim with 84 000 inhabitants (area 499 km2